much. it will decide what benefits should be covered and what preventive services you should receive. earlier this week the u.s. preventive services task force lemm l recommended women under 50 shouldn't receive annual mammograms. anybody who is concerned about this needs to understand this empowers a task force just like that to determine which preventive services should be covered by every hesitate plan in america. as one of the old members of the senate on both of the committees of healthcare jurisdiction i understand the complexities at work in comprehensive healthcare legislation. and i understand that this bill gets it wrong. instead of taking a step-by-step approach identifying consensus reforms to fix what is broken and leave what works, the majority leader has chosen a different approach. without republican support and without the approval of a

growing majority of american people, senator reid has chosen to shake nearly 20% of the at its foundation in attempting to jam through a strictly partisan bill. partisan bill. this bill will do nothing to improve the quality of our care. it will increase our nation's debt and deficit and it will harm our nation's tenuous job market. mr. president, there is no credible study and there will be no serious unbiased economist who will say that this bill will create jobs or strengthen our economy. and that's what the people in the recent election said was the most important thing to take care of. recently in an op-ed in the "wall street journal" the dean of the harvard medical school, dr. jeffrey flyer, gave the current health reforms a failing grade. this dean of the harvard medical school wrote about the reform bills being debated in congress, and he said that -- quote -- "there are no provisions to

substantially control the growth of costs or raise the quality of care, so the overall effort will fail to qualify as reform." that's the dean of the harvard medical school. dean flyer went on to write -- quote -- "in discussions with dozens of health care leaders and economists, i find near unanimity of that opinion. whatever its shape, the final legislation that will emerge from congress will markedly accelerate national health care spending rather than restrain it. likewise, nearly all agree that the legislation will do little or nothing to improve quality or change health care's dysfunctional delivery system." end of quote. i ask unanimous consent that this editorial be included in its entirety in the record at the conclusion of my statement. the presiding officer: without objection. mr. enzi: with ratings of

failed reform like the dean of the harvard medical school, we're talking about taking the time to tweak a failure of ideas so that we can say we did something. we're not fooling the american people *fplt the voices of august are still echoing and coming from a vast majority. other experts have weighed in on the provisions in the reid bill and their potential impact on jobs. one such provision is the job-killing tax of $28 billion that will fall disproportionately on the backs of small business employers in the form of a mandate on employers to provide washington government-approved insurance. this job-killing tax has been studied by the nonpartisan scorekeepers at the congressional budget office as well as nationally recognized economists and health skperpts. this -- health experts. these experts have said the cost

of this new tax will ultimately be paid by the american working men and women. businesses who cannot afford to provide health insurance will pass the cost of these new penalties on to their workers in the form of lower wages, reduced hours and jobs cut. yes, this so-called health reform bill will threaten your jobs. and if this vote is successful, we will spend weeks debating this bill. and just like the committee work so far, the majority will reject real solutions just like they have through the two amendment processes that have been merged to make this flawed bill. according to one recent study by the heritage foundation, this new job-killing tax in the reid bill will place more than 5 million low-income workers at risk of losing their jobs or having their hours reduced and an additional 10 million workers could see lower wages and reduced benefits. at a time of unprecedented economic peril, the majority has chosen to bring a bill to the

senate that will threaten our nation's jobs and economic growth. this bill will also increase our nation's growing debt and deficit, mr. president. currently our nation's debt is greater than $12 trillion and our deficit for fiscal year 2009 was greater than $1.4 trillion. as a percentage of the economy, our deficit is 10% of g.d.p., the highest its been since second world war. once again we're not debating this bill in a vacuum. rather, we're debating this bill at a time when our credit card is maxed out. i worry about the country that i'm leaving for my children and my grandchildren. our nation is being buried under a mountain of debt which poses a deadly threat to the future of our nation. the federal government will spend $1.4 trillion more than it receives in revenue this year. the government will make up that

deficit by borrowing more money, mostly from china and other foreign governments. these levels of debt are not sustainable and our foreign creditors are beginning to recognize that fact. as our creditors grow more concerned about our ability to pay our debt obligations, the interest rates we pay will grow. that means that it will soon cost us considerably more to allow washington to continue to borrow money than it needs to fund its current spending binge. with our current growing debt, congress should be concerned. think about it. our most fundamental duty as members of congress is to wisely meaning the power of the purse for our nation. the framers wisely put in place the process of appropriations that would be annually checked by the representatives of the american people here in washington. in this bill we create yet another stream of mandatory

spending in perpetuity, or until it runs out. it isn't reviewed by congress on any annual basis. i remind my colleagues that our federal deficit is nearly nine times the size of the deficit just two years ago. ask during the same two-year period, our nation lost 8 million private-sector jobs. our total federal debt is now around 85% of g.d.p. according to the david walker, the former head of the government accounting office, at the end of the fiscal year 2000, the federal government had about $20.4 trillion in total liabilities and commitments and unfunded promises for just social security and medicare. that number rose to $56.4 trillion at the end of fiscal 2008. that's 176% increase in just eight years. by the end of this year, that number is expected to rise to $63 trillion. with these staggering statistics, it's astonishing

that we're even debating a creation of a new entitlement, entitlement obligations forever. a couple of days ago, majority leader reid stated that this bill will be deficit-neutral. but yo you have to understand wt that means. first, the true cost of this bill is hidden by implementing the massive middle-class tax increases and medicare cuts in the first year and pushing the massive costs in health care subsidies out to the fifth year. republican leader mcconnell referred to this gimmick as being akin to paying a mortgage for four years before actually moving into the house. i want to emphasize that just a little bit because it is -- it is an accounting gimmick. you collect the money to begin with but you don't provide the benefits until further down the road. and then you say, well, we covered all those costs. but when you extend it on out, it won't continue to cover those

costs. so disaster. so i'm -- i'm -- as the only accountant in the senate, i'm shocked to see what would constitute as fraud in the accounting world seems to be the reason to hold a press conference to do a hollow boast. the gimmick gimmicks in this bie stunning, when it comes to the implementation of the tax on the so-called cadillac health plans or the increased taxes or the $464 billion in medicare cuts. medicare cuts? we're already having a problem with medicare solvency. it's going to go broke and we're going to take $464 billion from medicare. and then we're going to form sperm commission and -- a special commission and this commission will be able to tell us on an annual basis where we can make cuts in medicare so that it doesn't go broke. but let's see, there's a deal with the hospitals that they're not going to be touched and

there's a deal with the doctors that they're not going to be touched and, in fact, they're just going to be increased and there's a deal with pharma where they're not going to be touched. who does that leave? that means cutting benefits for seniors. they and home health care and nursing homes are the only places that you can cut it if you let those other people off the hook, and that's what the bill does. so when it comes to long-term care provisions in the bill that the budget committee chairman conrad has referred to as a ponzi scheme, you have to be a little bit worried. if washington accounting had to come under the same laws as private business, the administration and congress would be in jail. to attempt to claim the mantle of fiscal responsibility, the majority leader has jammed 10 pounds of entitlement spending into a five-pound sack. and, again, "entitlement" means

that the payments automatically go on forever, with no further review or constraint. that's not the fiscal responsibility, and the american people are not buying it. they know, evidently better than we do, what we're talking about. a large majority of americans believe their prescription drug costs will go up under this bill and that the cost of their premiums will go up, and they're right. what the c.b.o. score doesn't provide us with and can't provide us with is the cost of this bill to each and every one of us. but we know that that cost will be great. now, the c.b.o. evaluation says that -- that it's going to be paid for. paid for? that's an evaluation whether it's going to cost the government anything. it's not an evaluation whether it's going to cost the people anything. and the only place to get that money is from the people or, in

this case, also stealing it from medicare. in order for this bill to reduce the deficit, the majority leader has to assume that the medicare payments to physicians will be cut by 21% next year. he also has to assume that these payments will be annually cut another 5% for the next nine years. in order for this bill to reduce the deficit, the majority leader also has to assume that more and more middle-class americans will pay this new tax on high-cost health insurance plans. according to the congressional budget office, 84% of the revenue collected by this new tax will come from americans earning less than $200,000 in 2019. this reminds me of another tax which was originally intended to target just 155 individuals who made more than $200,000 and did not pay any income tax.

today the alternative minimum tax now hits millions of middle-class americans, and every year congress has to enact legislation to prevent it from hitting millions more. this bill's drafted that same way. it will creep up there and catch everybody in the increased taxes. in order to believe that this bill will reduce the deficit, its sponsors must believe that future congresses will allow millions of middle-class americans to be subject to these new taxes. while the majority leader claims that all these things will happen, the american public isn't fooled. in this morning's "washington post," the dean of washington's journalists, david broder -- not a politically conservative columnist and someone often cited by the other side -- pointed out that a recent survey found that less than one-fifth of the american people believe that health care reform will be deficit-neutral over the next 10

years. and by a 16-point margin, the majority in this poll say they oppose the legislation moving through congress. mr. broder called this legislation a budget-buster in the making. mr. president, it's difficult to quantify the scope of this bill. i've heard some of my colleagues talk about how many years would elapse in 2.5 trillion seconds. i've heard some of my colleagues talk about how many cars $2.5 trillion would buy or how many school districts it would fund, or how many decades it would fund state budgets across america. i don't think people are comprehensive -- understanding either how comprehensive this i don't think people are this understanding either howçç comprehensive this bill isç th entails 100% of the people. that is the difficulty with the group of six coming to

conclusions because it is so big we scratch the surface and find out what we don't know it takes a lot of research to make basic decisions. but it was easy enough to cram in a bill and say this solves it for a trillion dollars. we should never say a trillion dollars because that just sounds likes one and one is not a very big number. it is a thousand billion doélim we really don't know what a billion is either, but a billion is a thousand million. so, we are talking about a lot of money here. perhaps the best way to quantify this bill is it keeps me up night and more importantly the issues we are debating, keeps our constituents up at night. i'm sure everybody has beenç hearing from their constituents. we worry immensely about the cost an obligations we are

passing on to our children and grandchildren. where is this bill taking our country? and will we have the courage and time to preserve our nation's great strengths for future generations? these are the questions that keep me up and night and i know they are shared on the other side of the aisle. senator from nebraska, and i've sensed it my work over the summer with the chairman of the budget committee. i know that they share these concerns on the other side, and that's why i believe passionately that we must defeat the motion to proceed on this bill. i'm still an optimist and i still hope that we can start over and get to work on a bipartisan bill that has the trust and support of the american people. any major piece of legislation that has gone through this body has done so in a bipartisan way. it's been necessary to get the confidence of the american people, the confidence of the american people. they don't have confidence in congress right now, and this bill is not helping it.

you know, we say that we're spending our children and our grandchildren's money? actually, we're doing that plus spending our seniors' money. when you take medicare money, that's what you're doing. the seniors have figured it out. that's why it was so raucous in august and ever since. they have been concerned about their future and the promises that were made to them. we have a system that's going broke and then we're going to take money from it. we really ought to back up and make sure that medicare money goes to medicare. i know part of that's listed as fraud and abuse and i'm always fascinated when government talks about fraud and abuse, because we talk about it, but if we've known that these billions of dollars of fraud and abuse were out there, how come we haven't been collecting that money? and once we turn it over to the government to do that, it's no longer needed -- oh, it's needed

to pay the bills but it's no longer that much of a care, because the paid-for has already been taken care of. so i think there ought to at least be a separate account set up that you actually have to collect the fraud and abuse money before you can spend it, but we're not going to do that. and every senior can tell you some instances of fraud and abuse that they think are happening there, and we pass those on. i don't see -- i see some effort to collect that but not a lot. so, mr. president, as many of my colleagues know, before i came to the senate, i was a small business owner. my wife and i owned three small shoe stores in wyoming and montana. when i was showing someone a shoe and he or she said they didn't like it or couldn't afford it, i didn't try to just give them a sales pitch. i knew it was time to try to find another shoe, one that they liked and could afford. there's a lesson from this in this health care bill.

the people of america are complaining and we're showing them the shoe that we want to show them. and they don't want to see that shoe. they said, we thought you were going to lower my costs. we thought that every person -- every person out there thought they were going to have a benefit of some reduced costs, and they're not seeing it in this bill. now, they wanted to help out other people, and some of that's in here to a limited extent, but that isn't the main thing that they expected to have happen from this. small businesses out there are particularly hurting, and this will really react on small businesses, those shoe stores all over the united states, the grocery stores, the dry cleane cleaners. heck, this is even going to affect the doctors. they're small businesses, for the most part. so there's a lesson in this story when to comes to reforming health care, and it's time to

listen to the customers and find an alternative that they expected, that they want, and they can afford. probably the biggest help that's been to me in legislative has been that experience of working in a shoe store, because the people tell you what they want. and they've told us what they want. we haven't listened. you want to make the sale? you better listen. you better see how your inventory matches up to what they want. we haven't checked that inventory at all, or else we've said we don't have anything in here that you really need but we have some things that will take care of other people. and that's not going to sell. so, mr. president, we have a big decision to make tonight. it will have a lasting affect on our country, a lasting effect mostly in that if the motion to proceed passes, we're going to debate it for a long time. a bill of this size deserves a lot of time. it's necessary and it's more

comprehensive than we're going to be able to get into no matter how long we debate it. and so the american people are going to be surprised at the time that we waste when we could be solving jobs and the economy, which is their biggest concern at the present time. i'd ask that the rest of my statement be included in the record, and i yield the floor. the presiding officer: without objection.

the presiding officer: the chair recognizes the senator from montana. mr. baucus: i ask that further proceedings under the quorum call be dispensed with. the presiding officer: without objection. mr. baucus: mr. president, i ask unanimous consent that jacqueline lampert be granted floor prills for the consideration of h.r. 3590. the presiding officer: without objection. mr. baucus: a noted psychologist once said, to be mature means to face and national evade a crisis. our health care system is in a crisis. this crisis has been decades in the making, and history has made clear that this crisis will not solve itself. it is time for us to face the crisis. it is time for congress to show mature leadership. it is time for us to reform health care once and for all. for years now we have prepared

for this moment. the finance committee and the "help" committee studied the issues thoroughly. we have held nearly 70 hearings, round tables, and walk-throughs. we have studied this issue very thoroughly and exhaustively. we each produced a blueprint for reform, each committee, and we worked together with leader reid and president obama to combine those blueprints into one solved plan. this week, tonight, we have brought that plan to the senate floor. tonight we seek to begin that momentous debate. tonight we seek at last to face the crisis. we have a bill that'll put americans, patientsings and their doctors back in -- patients, and their doctors back in control. we have a bill that will end harmful insurance industry practices. under our bill, no longer will insurance companies be allowed to deny you health insurance; no

longer will insurance companies be allowed t allowed hike up prr americans for diseases like heart disease, cancer, or diabetes. no longer will health insurance companies be able to take away your health insurance, reduce benefits, when people get sick. under our bill, no longer will insurance companies be able to limit the amount of health care that you can use in a lifetime. no longer will insurance companies be able to put unreasonable limits on the amount of health care that you can use in one year. if you pay your bill, an insurance company must renew your coverage and provide your benefits. no longer will insurance companies be able to discriminate based on gender or health status. no longer will insurance companies be able to charge more for women or for people who are

sick. our bill will also require insurance companies to disclose a share of premiums that go to medical benefits. that's new and very important. no longer will insurance companies receive tax credits when they use your profits to provide excessive executive paychecks. our bill is fully paid for. it's fiscally responsible. it will lower health care costs, and it will reduce the federal budget deficit. according to the congressional budget office, our bill will reduce the deficit by $130 billion in the first ten years. over the next decade, it will further reduce the deficit by about a quarter of a percent of gross domestic product. that's hundreds of billions of dollars in deficit reduction. as well, our bill provides billions in tax cuts for

american families and small businesses. our bill will create new marketplaces called insurance exchanges. individuals and small businesses will be able quickly and easily to view, compare, and buy health insurance plans. today many americans already receive quality health care coverage through their employers. many are happy with their current insurance plans. this bill will not change that. we keep the best of our current health care system. people who are satisfied with their current health insurance coverage will be able to keep it. but too many others don't have access to insurance, to quality insurance. for too many, the system is broken. under our bill, new exchanges will provide one-stop shops where plant are presented in a simple, consistent format. americans will be able to know exactly what they are buying. insurance companies will have to

compete on price and quality, not on ability to select the healthiest people or hide restrictions. americans will be able to count on the health care coverage that they buy. and tax credits will help to ensure that all americans can afford quality health insurance. small businesses will also have access to exchanges and tax credits. through small business exchanges, these companies will be able to pool together, to spread their risk, increase their leverage, and enhance their choice just as big companies do. and members of congress will be required to buy their health insurance through the same exchanges that people in their own states use. exactly the same. no longer will there be a separate congressional health plan. our bill will strengthen medicare. it will improve benefits for seniors. and it will help to ensure that medicare is sustainable for

future generations. our bill will cut costs. it will not cut benefits. our bill will increase medicare benefits. our bill will provide seniors with free, preventive care and wellness checkups. it will improve care for seniors with chronic conditions and provide a 50% discount to help close the doughnut hope, the gap in benefit benefits of the medie prescription drug program. our plan is a good, commonsense our plan is a good common sense answer to the crisis facing american families an businesses. now on this floor, çhere, in t united states senate, tonight, we haveç an historic opportuni to consider this plan. we have the chance to make it even better. we hope to have a full debate. more important in the process or

rhetoric we have the opportunity atç last to face the crisis. we have the opportunity to show mature leadership. at long last we have the historic opportunity to reform healthcare once and for all. history is knocking on the door. let's open it. let's begin the debate to improve this bill before us today and provide the service that all americans expect to us perform when they elected us to this office. i yield the floor. >> the senator from connecticut. >> mr. president, i rise in very strong support of this melded bill, drafted and put together by our distinguished leader. the patient protection and affordable care act.

before i begin with some brief remarks, mr. president, let me extend my heartfelt therapist to our majority leader for his tireless work. i thank max baucus from montana for his tireless work. the members of the committees that have worked for the past many months to bring us to this moment. others this evening have spoken with great eloquence about the provisions of this bill, what we hope to achieve for our fellow citizens with the adoption of this legislation. i want to comment the senate health committee who did such heroic work during the writing of our portion of the bill. my colleagues tom harken of iowa, barbara mikulski. patty murray from the state of washingtoners so many others. i want to thank my republican committees of that committee as well. while we didn't end up with a bipartisan vote, at the end of

president,q we did end up adopting more than 150 amendments offered by our republican colleagues, which i think strengthened the legislation and made in a better piece of the legislation that we ha have. i want to pause for a moment if i can, mr. president, to recognize a colleague who is here tonight only in spirit, ted kennedy. so much has been said and written about his lifelockçç t to -- life-long quest to ensure that every american has decent healthcare. tonight we and the days to come will pay him the highest compliment by fulfilling that quest of achieving the goal that all americans aspire for and that is a national healthcarew3 our citizens. i would like to speak briefly to the american people who i

suspect areç just tuning inç this vote that will occurç why does this issue andv: debat matter? why are we hear on a satur@v evening evening? for thatxd matter, why are you watching c-span on aç saturday! evening? for one thing healthcare represents one-sixth of our economy and affects 100% of the population. it is true that skyrocketing healthcare costs are the single biggest threat to the final future of our fellow citizens. the reason tonight's vote is so historic beyondq those last two points is that never, ever before, never before, mr. president, has this body elected to serve the american people confronted directly this simple truth. nothing, absolutelyç nothing, matters more to you and to your family than the ability to get the healthcare you need when you need it from the doctor you

choose at a price you can afford. healthcare is ourq most basic need. healthcare is the most basic commitment that we should be willing to debate to each other. no matter what your familyw3 xd finances, no matter what your hopes and dreams are, no matter who you are, where you live or what your job is, in america , n the 21st century, you should be able to get the care that you need. butç for too many american families, perhaps your çfamily as you watch this tonight from your homes, healthcare has become your most basic fear. if you don't have health insurance, you go to bed every single night knowing that ifçó u wake upw3 sick, your child does you might not be able to see that doctor or afford one even if you can find one. even if you have no health insurance you are paying more in

premiums and getting less coverage for your money. millions of you are seeing your premiums skyrocket. yet you liew3ç awake at night wondering whathey i lose my job, what if i get t(sick, and find t cot of the careç of need. or, even worst, your insurance company cancels yourç policy altogether. what if you run out of benefits and have to pay out of your pocket? i wish i couldw3 say these fear are irrational fears, but they are not, mr. president. there is nothing irrational about those fears. insurance doesn't allow you to be sure of anything. our system is broken. people are losing their homesç because they get sick, people are dying because theyçç can' afford a cure. this is just not acceptable in our america, mr. president. that is why we are here on a

saturday night. if you watchedç the newsç thet two months you probably noticed there is a wide range of opinions on how we should fixç this. and that is asç it should be, ç president. we need all the goodçw3 ideas can get. andnof hopefully this debate wi produce that. but if you have watched the debate the last phenomena days in the senate you probably have noticed something else as well. i don't believe a single persony point and said that we areçt( doing nothing at all. therefore,ççó in the weeks ahe- >> time has expired. >> a full and open debate to every provision of this bill. but tonight's vote is nothing more than a choice, a choice between doing something and doing nothing. i would urge my colleagues this evening to join us hopefully q unanimously, to say we should dr something, we should do something about thisok most bas right that all americansñr deserve. i yieldç thet( floor.

mr. mcconnell: mr. president? the presiding officer: the republican leader's recognized. mr. mcconnell: mr. president, the nation is watching the senate tonight. the american people know how important this vote is. they've seen the bill -- the democratic leaders -- the bill that the democratic leaders want to impose upon them, and they want to know where the rest of us will stand. this bill itself is a massive monument to bureaucracy and spending. but at its core it's really

quite simple. at a moment when more than one out of 10 working americans is looking for a job, at a time when the chinese are lecturing us about our debt, this bill -- this bill right here cost costs $2.5 trillion government doesn't have. and can't afford. it imposes punishing taxes on almost everyone. it raises health insurance premiums on the 85% of americans

who already have health insurance. and if that were not bad enough, it slashes medicare by half a trillion dollars. anyone who votes aye tonight, mr. president, is voting for all of these things. now, mr. president, it is a fact, a vote in favor of proceeding to this bill is a vote in favor of adding to the tax burden of the american people in the midst of double-digit unemployment. a vote in favor of proceeding to this bill is a vote to raise health insurance premiums on people who were told -- they were told that they could expect

their health insurance costs to go down. a vote in favor of proceeding to this bill is a vote in favor of deep cuts to medicare for tens of millions of seniors. -- seniors who depend on it totally. a vote to proceed to this bill is a vote to continue the completely out-of-control spending binge congress has been on all year. a vote in favor of this bill tells every american family sitting in a waiting room tonight wondering when they'll get to see a doctor or how much it's going to cost, it's not our

concern. and worst of all, a vote in favor of this bill is a vote in favor of the spending binge that's leading to a massive and unsustainable long-term debt that will smackl shackle our chn to a future they can't afford. that's what tonight's vote is all about. if it wasn't, none of us would be here on a saturday night with the nation watching and waiting to see what we do here. they're watching because they know that none of this -- none of this is inevitable. all it takes is one vote, just one. the simple math is this, if

there were one democrat, just one of our friends on the other side of the aisle -- just one who would say no tonight, none of this would happen. the voices of the american people would be heard. we've seen all the surveys. we know how they feel. if just one democrat were to say no tonight, he'd be saying no to the premium increases, no to the tax cuts, no to the medicare cuts. just one on the other side of the aisle. and then we could start over with a commonsense step-by-step approach to fix the problem that got us here in the first place, and that was that health care costs too much.

now, purchas mr. president, thed irony of this whole debate, the problem that got us here is that health care costs are out of control. and, yet, the neutral nonpartisan congressional budget office, the score keeper around here, says that under this bill -- this massive bill, health care costs are actually going to go up, not down. and the american people thought that's what this whole debate was about in the first place. so 2,074 pages and trillions of dollars later -- 2,074 pages, and trillions of dollars later, this bill doesn't even meet the basic goal that the american people had in mind and what they thought this debate was all

about to lower costs. this bill will actually make the situation worse. and now we're about to vote on it. now, we've heard some senators come to the floor today and say that they oppose this bill, but they don't want to stop the debate. they oppose the bill, but they don't want to stop the debate. mr. president, nobody's suggesting we stop the debate. no one. not a single senator on this side of the aisle have i heard suggest that we stop the debate. but if we don't stop this bill tonight, the only debate we'll be having -- the only debate we'll be having is about higher

premiums, not savings for the american people, higher taxes instead of lower@@@@@ å >> that is not what we have in mind to end the debate. what we want to do is change the deba debate. not end it, change it. because once we get on this bill, ladies and gentlemen, the basic dimensions will not cha e

change. the basic dimensions will not change. so, i ask why should we consider a bill we already know the american people oppose? this is not anything anybody is in doubt about. the american people think if you don't like this bill you have an obligation to try to stop it. and that opportunity will come at 8:00. a surprise to any member of senate, but it's going to take 60 votes to change this bill. that means the bill is introduced, this thing we're looking at right here, will fundamentally be the bill we'll be asked to pass sometime in the future. that is a fact.

now, after tonight's vote we'll all go home and face our constituents. we'll have to tell them how we voted on raising their premiums, raising their taxes, and cutting their medicare. for some of us that's not going to be a very easy conversation. but it doesn't have to be that way. if you really want to lower costs and premiums, then we can work together step by step and pass the commonsense reforms the american people have been asking for all along. we can end jian junk lawsuits at

doctors and hospitals which drive up costs. we can encourage healthy choices like prevention and wellness programs which hold down costs. we can lower costs by letting consumers buy coverage across state lines. we can allow small businesses to band together to get lower insurance rates. and certainly we can address the rampant -- absolutely rampant waste, fraud, and abuse that drive up cost. all of those, my colleagues, are changes worth making. the american people are looking at the senate tonight. they're hoping we say no to this

bill. so we can start on a better plan that fixes the problem that the american people care about most, than is cost. they want us to start over. there's nothing about this massive bill that they like. they want us to start over. they want us to address their real concerns. all it would take, mr. president and my colleagues, is just one member of the other side of the aisle, just one, to give us an opportunity not to end the debate, but to change the debate in the direction the american people would like us to go. i yield the floor. a senator: mr. president?

the presiding officer: the majority leader. mr. reid: my dear friend, the republican leader, has had since wednesday to read this bill. obviously he hasn't done so. because the facts he's talking about do not exist except in the mind of a few people who don't understand this legislation. now, mr. president, for 200 years we've styled ourselves, the world's greatest deliberative body, deliberation necessarily implies discussion and great issues, necessarily require great debate. today we vote on whether -- to even discuss one of the greatest issues of our generation, indeed, one of the greatest issues this body has ever faced. whether this nation will finally guarantee its people the right to live free from fear of illness and death, which can be prevented by decent health care for all. in the coming weeks, we'll finally put people, not insurance companies, in charge

of their lives. the road to this point has been started many times. it has never been completed. merging two such large and consequential bills has never been done before. it's been an enormous undertaking and we would not be in the position without the unflagging dedication of many senators and extremely loyal staff members. at the top of the list are chairman baucus and dodd, who've shown dedication, determination in recent weeks and months that's rarely been seen. i'm proud of every single senator's input and especially proud of the two most recent classes of senators, elected with strong mandates for progress, they've demonstrated a studious approach to our historic endeavor and an unwavering belief that all americans should be able to afford to live a healthy life. mr. president, i want to explain why we're holding this important vote at this hour. as a matter of principle that i respect, the senior senator from

arkansas insisted that we vote not only after senators had the time -- only after senators had the time to read and understand this bill. senators all have now had ample time to do so and that is because of the chairman of the agriculture committee, senator blanche lincoln of arkansas. mr. president, as i have done many times this year, privately and personally, as well as publicly, i again invite my colleagues, my republican colleagues, join on the right side of history. i again invite them to join us at the very least in a debate about our future. around dining room tables in nevada and across the nation, families are agonizing over what to sacrifice next to buy health insurance. they're questioning whether to fill a prescription or go without it and hope for the best. employers are wondering whether they can afford to provide health care to their employees. they're asking how their businesses can survive while health care costs grow faster than ever.

americans need health insurance reform. debate is constant between television commentators, the editorial pages of great newspapers and magazines, but, mr. president, the only place where silence is even considered is here in the united states senate. now, tonight, finally we have the opportunity to bring this debate where it belongs. we finally have the opportunity to bring this great deliberation to this great deliberative body. that and nothing more is what tonight's vote does. a yes vote says to america, i know this issue is important to your family and to our country and the senate should at the very least talk about it. let's be real transparent. beyond all the hype and hyperbole and the hyperventilation, that and nothing more is what tonight's vote does. a yes vote says to america, i know the issue is important to your family and to our country and the senate should at least talk about it.

mr. president, some of my republican friends would like the american people to think that voting to debate the bill is voting to pass the bill. any high school civics textbook will tell you the suggestion is absolutely false. tonight's vote is not the end of the debate, it's only the beginning of the debate. it's clear by now that my republican colleagues have no problem talking about health care: radio interviews, television interviews, press conferences, little town hall meetings. my distinguished counterpart, the republican leader, has given many speeches in this chamber on the issue of health care reform, yet now that we have the actual legislation to debate, to amend, to build on, now that we have a plan on paper and not just wild rumors, well, they refuse to debate. after all, if we're not debati

debating, if we refuse to let the senate do its job, what are we doing here? if senators refuse to debate about a profound crisis affecting every single citizen, the nation must ask: what do you fear? and whose voice do you speak? and whose interests do you vote? surely, deliberating health reform can't be more difficult than deciding, as americans have to do, whether to pay your mortgage or to pay your medical bills. it can't be more painful than not taking your child to the doctor because it costs too mu much. it can't are more humbling than facing your own employees and telling them, "i'm sorry, you can't count on me for your health insurance next year. you're on your own." and it can't be more upsetting than having an insurance company take away your coverage at the exact moment you need it the most.

my republican friends, there's nothing to fear in debate. president kennedy once said -- and i quote -- "let us not be afraid of debate or discussion. let us encourage it." be not afraid of debate -- it's our job, and it's exactly what the legislative process is all about: discussing, amending, improving. we democrats stand ready to do what needs to be done. we welcome debate. we encourage debate. does any united states senator seriously think the founders conceived the senate and its rules in hopes that legislation would never be deliberated? of course not. did the framers of the constitution explicitli enumerae the powers of the senate but in truth hope this body avoided the hardest and most urgent questions of the day? of course not. did our nation's visionaries build this building, this capitol building, and design this great chamber that we stand in tonight only so that it would

remain dark and silent? quite to the contrary. imagine if instead of debating either of the historic g.i. bills, legislation that have given so many brave americans the chance to brave college, if this body had stood silent. imagine if instead of debating the bills that created social security or medicare, the senate's voices had been stil stilled. imagine if instead of debating whether to abolish slavery, instead of debating whether giving women and minorities a right to vote, those who disagreed were muted, discussion was killed, there would be no vote. so i say to my republican senators, don't try to silence a great debate over a great cris crisis. don't let history show that when given the chance to debate and defend your position, to work with us for the good of our country and constituents, you ran and hid. you cannot wish away a great

emergency by closing your eyes and pretending it doesn't exist. there is an emergency and it exists, and it exists now. the right response to disagreement is not dismissal. it's discussion. democracy is discussion. democracy needs deliberation. let us debate our differences. on some, we'll find common ground. on others, we may not. but let's at least tell america, its legislators, the united states senate is willing to find where we -- where we can come together. nobel prize awardee andrei sakharov, one of the great thinkers of the past century, knew that when opposing sides come together, the sum of their ideas can outweigh its parts. sakharov said, and i quote, "profound thoughts arise only in debate with the possibility of counterargument." so come on, my friends. let us share our ideas here in the united states senate.

let us legislate. let us negotiate. let us deliberate. let us debate. our country cries for this debate. our country deserves this deba debate. our country needs this debate. [captions copyright national . cable satellite corp. 2009] [captioning performed by national captioning institute] .